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Clinical schools and educational institutions have a social responsibility and contract to contribute to strengthening the capacity of the rural workforce, writes Susanne Tegen.
The Medical Schools Outcomes Database (MSOD) National data report 2025 is an important data collection mechanism about medical career intention which can be translated into future workforce planning policy and programs.
The data provide a critical lens to examine areas for improvement of the dispersion of the medical workforce as well as broader implications for the development of rural education initiatives.
The statistics outlined in the 2025 MSOD survey reinforce the importance of relationships and echo the successful outcomes of previous programs, including the Rural Australia Medical Undergraduate Scholarship (RAMUS) Scheme, which was administered by the National Rural Health Alliance between 2000 and 2023.
Clinical schools and educational institutions have a social responsibility and contract to contribute to strengthening the capacity of the rural workforce. Fulfilling this obligation requires a stronger, rurally focused, collaborative educational model. Medical students must be supported to foster place-based connections through meaningful rural education and placements as a pathway to mobilise and retain a sustainable rural health and medical workforce.
The data findings
The 2025 MSOD demonstrated a strong correlation between domestic students and preference for engaging in rural and non-metropolitan practice, with 30.4% of domestic students reporting a preference for non-metropolitan practice, compared to 20.1% of international students. About 23–25% had completed their secondary schooling in regional areas, equating to approximately one-third of respondents. Almost one-quarter (24%) of respondents also self-reported that they came from a rural background. Interestingly, 62% of respondents who self-reported a rural origin expressed their preference for practising outside a metropolitan location.
Rural club memberships have declined to the lowest level in five years to a total of 464 students in 2024 (21% membership rate). However, rural club membership continues to be a strong correlating factor in future rural practice. Rural club members were found to be six times more likely to express preference to practise outside metropolitan regions compared with those who were not members, showing the importance of peer networks in rural practice.
Rural placement leads to rural practice
Consistent rural placement is a strong correlating factor determining intention to practice rurally. Of particular importance is the need to build capacity in rural general practices, and community and industry to support more medical student and prevocational trainees. Indeed, these linkages will give greater understanding of context and health needs, as well as allow friendships to develop.
Building this capacity will bolster the rural connections for students and provide strong rural communities of practice and supportive networks, further enabling future rural practice.
More than a year of rural placement translated into 31% of students expressing a preference for future practice in a rural or remote area. This preference for rural practice decreases with shorter exposure to rural practice through placements, translating to 23% for those who undertook six to twelve months of rural placement, 8% rural preference for placements less than six months, and 3% for students who did not undertake a rural placement.
Forming strong place-based connections and exposure to positive rural practice experiences are imperative in determining future rural practice intention. The data show that there is a strong psychological element that factors into this decision making. Not only is community connection an important aspect of rural practice, but it is also an important element of rural life. People living in rural communities are reportedly more likely to engage in volunteering activities, and report higher rates of community connectedness and personal safety and overall higher relationship satisfaction.
Scholarship and mentorship
The National Rural Health Alliance-administered RAMUS Scheme was funded by the Australian Government from 2000 to 2023. The RAMUS Scheme was grounded in providing place-based connections to leverage rural connections and cultivate workforce and educational development outcomes through strong mentorship and financial support. The Scheme provided mentorship opportunities through the Rural Doctor Mentor Program, which paired each scholar with a rural medical mentor. These connections facilitated place-based learning, embedded principles of rural health, and fostered connections between students and rural communities.
In addition to mentorship, it was a requirement that RAMUS recipients were members of their rural health club, further embedding recipients into a community of rural practice and promoting long term rural health and workforce relationships and outcomes. During the scheme’s 23-year lifetime, there were more than 2500 RAMUS recipients, with approximately 88% of recipients practising medicine an extremely positive outcome. As of 2023, 862 RAMUS scholars worked in rural and remote areas (RA2-5) out of a total of 2238 scholars.
The role of universities
The tertiary education sector, as well as postgraduate training programs, funded by taxpayers, have a moral, ethical and social responsibility to rural Australia, which makes up 30% or 7.3 million people, who also make an enormous economic contribution to Australia as a whole. Careers in medicine are not viewed as achievable for many students in rural areas. This is due to the prolonged geographical, social, education access, financial and self-efficacy barriers that rural students face.
Medical schools must proactively engage in rural communities and lead community-centred recruitment and retention for rural-origin students. Indeed, there are further opportunities to train predominantly in rural Australia, with modules in the city, rather than the other way around.
Data consistently demonstrate that rural communities are a severely underutilised and undersupported resource for producing a domestic health care workforce. The Strengthening Medicare Taskforce report advocates the need for making primary care a first-choice career. To achieve this, rural clinical schools must provide positive immersive experiences in rural practice, and support students with accommodation and cultural integration and a rurally multidisciplinary-focused curriculum. Funding must be equitably spread to the country for education, training, supervision and infrastructure. Through a strongly defined social and economic mission, universities can orient the future of rural practice and a commitment to communities through cultivating stronger interest, understanding and support of the value of working in rural, remote and regional communities.
Conclusion
The current data demonstrate a desire to practise rurally among a significant portion of students, particularly domestic students and those of rural origin.
What is missing is the supportive educational mechanisms and investment to foster meaningful and long-term growth and sustainability that will translate into workforce outcomes. In addition, post-graduate clinical training is a great opportunity to train in rural areas. What is needed is support for this to occur. If governments, medical colleges and associations are serious about workforce shortages, the health of all Australians and, importantly, the productivity of Australia, a genuine investment needs to be made to ensure that end-to-end training opportunities in rural areas are funded and implemented around Australia, not just for a lucky few.
A collaborative approach to education, health, finance, infrastructure and workforce policies must be implemented to leverage this interest and to break the cycle of workforce shortages. To do less is a lost opportunity, indeed, a waste.
Susanne Tegen is the Chief Executive of the National Rural Health Alliance.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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